cardio patho

what is the most common cause of death in developed countries

atherosclerosis (elevated lipids, a type of arterialsclerosis)

what is the most common cause of congenital heart diseases

idiopathic

isolated septal defects are initially ___, but later they may become _____ when the ______

noncyanotic, cyanotic, direction of blood flow through the shunt is reversed

is atrial septal defect (ASD) cyanotic or noncyanotic

noncyanotic

what is the cause of atrial septal defect

result of an incomplete closure of the foramen ovale

which was is the blood flowing in an atrial septal defect

from left atrium to right atrium (oxygenated blood going to nonoxygenated side)

what are the symptoms of an atrial septal defect

often asymptomatic, murmurs, fatigue, sob

what do you need to diagnose an atrial septal defect

an ecocardiogram

what are the 2 broad categories of congenital defects

cyanotic and noncyanotic

what is a cyanotic congenital defect

blood flowing out of the heart to the body is not oxygenated

what is a noncyanotic congenital defect

blood flowing out of the heart to the body is still oxygenated

if youve got a valve prob what do you need to diagnose

echocardiogram

what is a ventricular septal defect

a hole in the interventricular septum (between left and right ventrical)

what is a potential long term consequence of both atrial septal defects and ventricular septal defects

right side hypertrophy/failure and pulmonary hypertension

which way is blood flowing in a ventricular septal defect

from left ventricle to right ventricle

is a ventricular septal defect cyanotic or noncyanotic

cyanotic

symptoms of a ventricular septal defect

heart murmur, sob, failure to thrive

which side of the heart is stronger in VSD

right

ventricular septal defect AKA

Eisenmenger syndrome

can you treat a VSD

no :(

what is a tetralogy of fallot

a combo of 4 heart defects

is tetralogy of fallot cyanotic or noncyanotic

cyanotic

what 4 heart defects do you have in tetralogy of fallot

pulmonary stenosis, ventricular septal defect, right verntricular hypertrophy, overriding aorta (between L and R ventrical)

symptoms of tetralogy of fallot

cyanosis (gets worse when excited/running, kid gets into squatting position to self regulate blood flow), difficulty feeding, failure to thrive

atherosclerosis definition

a systemic disease effecting the arteries

what cuases atherosclerosis

elevated lipids and inflammation

what do elevated lipids and inflammation lead to in atherosclerosis

endothelial cell injury

why is diabetes such a big cause of atherosclerosis

bc sugar is inflammatory as hell, causes endothelial cell injury and cells get dysfunctional → lipids penetrate → wbcs eat lipids and turn them into foam cells → foam cells (v fragile) build up plaque → leads to atherosclerosis

what is a precursor to injury

inflammation

modifiable risk factors for atherosclerosis

diabetes, high cholesterol, htn, smoking, obesity, sedentary life style

nonmodifiable risk factors for atherosclerosis

age, gender, family history

major complications of atherosclerosis

heart attack, stroke, aneurysm, peripheral artery disease

what does the coronary form of atherosclerosis affect

coronary arteries, leads to coronary artery disease and MI

what does the cerebral form of atherosclerosis lead to

stroke

what does the aortic form of atherosclerosis lead to

aortic aneurysms

what does the peripheral form of atherosclerosis lead to

peripheral artery disease, gangrene

factors that affect clinical presentation of coronary heart disease

where the occlusion is, how fast it formed, extent of atherosclerosis in other branches, presence of other diseases (htn, graves)

clinical features of coronary heart disease

congestive heart failure (heart starving and dies), angia pectoris (chest pain secondary to occlusion), heart attack

features of slowly progressing atherosclerosis

causes hypoprofusion and ischemia, leads to angina pectoris, may progress to congestive heart failure

features of quickly progressing atherosclerosis

causes heart attack

which artery will be affected in the anterior wall in a MI

left anterior descending art (anterior interventricular artery)

which artery will be affected in the lateral wall in a MI

left circumflex art

which artery will be affected in the right ventricle/ posterior wall in a MI

right coronary art

omg your patient is having a heart attack in the ER, where do you need to take them and why

take them to the cath lab so you can profuse the heart (meaning you work around the blockage, put in a stent)

potential complications of MI’s

endocardial mural thrombus, cardiac tamponade, ventricular aneurysm

what happens if you get an endocardial mural thrombus

greatly reduced EF bc you got a big ass clot on the inside of the ventricle

how can you diagnose coronary artery disease

EKG, blood tests, cornary angiography, echocardiography, stress testing (you runnin bitch)

treatments for coronary artery disease

lifestyle mods, meds, surgery

pathogenesis of cerebral atherosclerosis

plaque buildup in cerebral arteries, reduced blood to brain, risk of plaque rupture and embolism

symptoms of cerebral atherosclerosis

transient ischeic attacks (mini stroke), stroke, cognitive decline

complications of cerebral atherosclerosis

stroke, either ischemic or hemorrhagic

pathogenesis of aortic atherosclerosis

plaque buildup in aorta, weakening of arterial wall, mostly seen in abdominal aorta, risk of aneurysm formation

symptoms of aortic atherosclerosis

often asymptomatic until severe, back pain, pulsating feeling in abdomen

complications of aortic atherosclerosis

aortic aneurysm, aortic dissection, can lead to sanguination and bleed out

pathogenesis of peripheral atherosclerosis

plaque buildup in arteries supplying limbs, reduced blood flow to extremities

symptoms of peripheral atherosclerosis

intermittent claudication (aching leg pain when walking), numbness or weakness in legs, ulcers or sores that dont heal bc poor blood supply

complication of peripheral atherosclerosis

critical limb ischemia, gangrene

hypertension definition

chronic condition characterized by high BP (140/90)

primary hypertension=

htn w no identifiable cause, 90-95% of cases

contributing factors to primary htn

genetics, lifestyle, diet, stress (these are not CAUSES, can quit smoking or loose weight and may still be hypertensive)

secondary hypertension =

htn caused by underlying causes (renal disease, endo disorder etc)

examples of secondary htn

pheochromocytoma, kidney disease

consequences of htn

left ventricular hypertrophy, damage to aorta, damage to arteries and arterioles, accelerates atherosclerosis, risk of htn stroke, brain ischemia, retinal changes impairing vision

lifestyle mods for htn management

reduced na intake, inc fruits and veggies, regular workouts, weight loss, stop smoking

meds to treat htn

diuretics, beta blockers, ACE inhibitors, calcium channel blockers, angiotensin 2 receptor blockers)

which med for htn fixed day to day bp but didnt improve morbidity/mortality

calcium channel blockers

which med for htn didnt really lower day to day bp but did improve morbidity/mortality

ace inhibitors

what are rheumatic heart diseases

systemic, immunologically mediated disease related to strep infection (THIS IS WHY WE GIVE ANTIBIOTICS FOR STREP)

what heart tissues are inflamed in rheumatic heart disease

the endocardium, myocardium and pericardium

what does rheumatic heart disease often affect

the valves

pt presents in er w clear jagged movements (chorea) as they walk in, and complains of chest pain. says they had strep a few weeks ago but didnt get it treated bc they dont have insurance and figured its go away on its own. what are ya thinking

rheumatic heart disease

common infection type for endocarditis

bacteria

common infection type fro myocarditis

virus

common infection type for pericarditis

bacteria, virus, or autoimmune

endocarditis =

heart valves bad

myocarditis =

heart muscle bad

pericarditis may lead to

pericardial tamponade

what physical injury may lead to pericarditis

seatbelt bruise

21yo pt presents to the er, overall healthy but says they caught a cold a while ago and now they have significant chest pain. you take an ekg and it looks like theyre having a heart attack. what do you think is actually up bc it sure aint an MI

pericarditis

clinical features of endocarditis

feaver, heart murmurs, embolic pneumonia, risk of heart failure and systemic emboli

clinical features of myocarditis

fever, chest pain, heart failure symptoms, arrhythmia, sudden cardiac death

clinical features of pericarditis

chest pain (like a stabbing pain), pericardial friction rub, pericardial effusion, risk of cardiac tamponade, looks like an MI on an EKG. pt cant sit still, doesnt wanna lie down, is leading forward

types of cardiomyopathy

dilated, hypertrophic, restrictive

dilated cardiomyopathy =

reduced EF, big floppy heart

dilated cardiomyopathy cause

often idiopathic, maybe alc, viral infection, or genetic factors

dilated cardiomyopathy clinical features

enlarged heart chambers, reduced systolic function

dilated cardiomyopathy symptoms

fatigue, sob, edema, thin myocardial walls

hypertrophic cardiomyopathy=

big ventricular septum

hypertrophic cardiomyopathy pathogenesis

genetic mutations affecting cardia muscle proteins

hypertrophic cardiomyopathy clinical features

thick ventricular walls, esp in the septum

hypertrophic cardiomyopathy symptoms

chest pain, dyspnea, syncope, sudden cardiac death (young athletic pt “suddenly drops dead” type beat)

restrictive cardiomyopathy =

ventricular stiffness

restrictive cardiomyopathy pathogenesis

infiltration of myocardium w abnormal substances (like amyloid)

what is the EF in restrictive cardiomyopathy

normal or slightly high, but space dec in size

restrictive cardiomyopathy clinical features

stiff ventricular walls, impaired diastolic filling

restrictive cardiomyopathy symptoms

fatigue, sob, peripheral edema, plaques on muscle fibers, muscle now cant contract as well and is stiff

general cardiomyopathy symptoms

fatigue, sob, edema, arrhythmia

how do you diagnose cardiomyopathies

echocardiogram, mri, genetic testing, biopsy

definitive testing =

more invasive